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Answering Questions About the P.S.A. Test

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News that an influential panel of experts is advising healthy men not to be screened for prostate cancer with a widely used test is certain to cause confusion and anxiety among men and their doctors, and reignites a debate about the benefits and risks of screening tests.

The recommendations, to be officially announced on Tuesday by the United States Preventive Services Task Force, affect more than 44 million men age 50 and older who typically are candidates for a simple blood screen call the prostate-specific antigen (P.S.A.) test.

The panel, which already recommends against P.S.A. screening for men age 75 and older, will cite recent research suggesting that the testing does not save lives but does lead to unnecessary treatments that can cause impotence, incontinence and a number of other complications.

Here are some answers to common questions about P.S.A. testing and what the task force recommendations mean for men.

Will the new recommendations prevent me from getting a P.S.A. test if I want one?

No. Whether to be screened for prostate cancer is still a decision that each man must make for himself with the advice of a doctor he trusts. But now that the independent panel has taken a stand, many doctors who were ambivalent or opposed to P.S.A. testing may be more willing to express their own doubts about the test and to advise patients against it.

What if I have a family history of prostate cancer or worrisome symptoms? Should I still be checked for cancer?

The panel’s advice is based on studies of healthy men. Men who have symptoms related to prostate health should always be seen by a doctor; the task force did not address whether P.S.A. testing is appropriate for them. And men with a strong family history of prostate cancer may have more to gain from screening than men at low risk, so they also should discuss the issue with their physician.

In addition, a man who already has prostate cancer that has been diagnosed or treated is likely to continue to undergo P.S.A. testing, which can help doctors determine whether cancer has returned or is spreading.

What do other groups say about P.S.A. testing?

Most major medical groups have not taken a stand against routine P.S.A. screening and say it is a decision a man should discuss with his doctor. The American Cancer Society suggests that the conversation start at age 50 for most men, earlier for African-Americans and men with a strong family history of prostate cancer.

The American Urological Association recommends that P.S.A. screening be offered to men 40 or older. Most organizations discourage prostate cancer screening for men with less than 10 years life expectancy.

Why not get screened? Isn’t it always better to find cancer early?

The argument against P.S.A. testing is that prostate cancer is typically so slow growing that most men would be just fine if they never knew it was there. But once cancer is detected, it is psychologically difficult for a man to do nothing.

As a result, tens of thousands of men each year are left impotent and incontinent as a result of aggressive treatment for a cancer that would never have caused them harm. But it is impossible to tell which men have comparatively benign cancer and which men have aggressive cancer. As a result, many doctors believe the overall benefits of screening outweigh the negatives.

How much weight do the task force recommendations carry?

The task force is an independent panel of experts in prevention and primary care appointed by the federal Department of Health and Human Services. While the group only makes recommendations, a change by the task force often prompts other organizations to review their guidelines and can influence how insurance companies reimburse for certain services.

But the influence of the panel is often determined by how controversial its recommendations are. Two years ago, for instance, the task force concluded that healthy women under age 50 should no longer get annual mammograms. That recommendation was met with strong resistance by many cancer organizations, women and their doctors, many of whom continue to ignore it.

And even though the panel has already recommended that men over age 75 not undergo P.S.A. testing, many men and their doctors continue the practice. Earlier this year, The Journal of Clinical Oncology reported that men ages 80 to 85 are being screened as often as those 30 years younger. The task force’s advice is not necessarily the final word.

 

What are the Benefits of Pro-Vas

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Women have always had a number of contraceptive options to choose from, while men only have ever had really one option provided to them, which are condoms. Those couples wanting a strong form of birth control have had to rely on women and the use of birth control pills to hinder the possibility of unwanted pregnancies. The only contraceptive option previously for men is a permanent one that could not be reversed – a vasectomy. However, now there is a brand new male contraceptive device that only takes up to 15 minutes to implant, does not require any cutting and is a completely reversible procedure. Known as Pro-Vas, it is the very first male contraceptive procedure widely available. It calls for implanting a very small titanium spring clip in the vas deferens to stop the flow of sperm to the prostate, where it will mix with the semen. While sperm will still be produced in the testicles, it will not make its way through the vas deferens. Rather, the sperm ends up absorbed throughout the body.


There are a number of significant benefits associated with Pro-Vas aside from being a very reliable form of birth control without the associated pain and irreversibility of a traditional vasectomy. There is little to no post-procedural pain associated with Pro-Vas and it is a much quicker procedure than a vasectomy. It is very non-invasive as there is no general anesthesia involved and men can leave same day. There are no associated complications like vasectomy and the recovery time is much quicker, allowing men to return to their normal everyday activities a lot quicker. Unlike a vasectomy, Pro-Vas can be reversible through a standard procedure known as a vasovasostomy.


Prior to electing to undergo the Pro-Vas procedure, men should first speak to their loved ones as it is a very important decision. If men no longer want to worry about unplanned pregnancies and want to stop dealing with temporary methods of birth control, the Pro-Vas procedure can be extremely beneficial. Pro-vas does not affect erections, sex drive, climax sensation, quality of sperm, the scrotum, or the testicles. Many men state that by undergoing the Pro-Vas procedure, they have been able to increase the spontaneity in their sexual relationship, something they were unable to do beforehand.


One thing that men need to keep in mind is that they will not be sterile as soon as the Pro-Vas procedure is done. Therefore, they will need to continue using an alternative type of birth control. Many doctors that perform this procedure say that men need to wait up to three months after the device is implanted as the body still needs to get rid of the sperm that is still in the system, namely the prostate. Many medical professionals will offer to do a sperm check at weeks six and twelve post procedure. These checks see if there is still any sperm left and if the device is working and will remain a viable form of contraceptive

 

What is HIFU?

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Through the evolution of modern medicine, medical physicians have now come up with a new prostate cancer treatment known in many circles as HIFU, which stands for high intensity focused ultrasound. This new technology assists men suffering from prostate cancer by getting rid of all cancer infected tissue in the prostate region using an advanced acoustic ablation method that utilizes the powers of an ultrasound. This technology locates the infected area with pinpoint accuracy. The infected area is targeted using sound waves allowing HIFU to elevate the tissue’s temperature, making the tissue breakdown and consequently eliminating the cancer.


Numerous physicians are now recommending HIFU to their prostate cancer patients due to the limited number of harmful side effects associated with the procedure. HIFU offers patients a procedure that is controlled and precise, thereby limiting side effects, such as erectile dysfunction and incontinence, which are common with other treatments for prostate cancer. A prostate cancer patient only needs to devote up to three hours for this procedure and may leave mere hours after the procedure it done. They just have to wait for the anesthesia used to minimize discomfort to wear off. HIFU is non-ionizing and does not utilize radiation. Therefore, HIFU treatment can be used on a number of occasions without damaging healthy tissue. Due to this, physicians use HIFU when they do not see successful results using other prostate cancer treatments.


The Sonablate 500 is possibly the most well known HIFU therapy option utilized for the treatment of prostate cancer. It is currently used in a number of hospitals and clinics around the world. It is controlled through a computer and delivers the HIFU energy directed right at the infected area via a small rectal probe. Through this action, all tissue infected by cancer is eliminated. Through the use of integrated biplanar ultrasound imaging, relating planning and monitoring is offered throughout the duration of the treatment, as well as images both before and after of the entire infected region.


To understand how the HIFU system works, think about what happens when the sun’s rays are focused through a magnifying lens. HIFU offers the same type of precision focusing through the use of ultrasound energy. By focusing this ultrasound energy on the infected area, the temperature of that area is raised, killing the tissue. At the same time, unaffected areas remain unharmed and their temperature remains unchanged. Once the procedure is complete, the physician has the ability to monitor the location of the precise lesion. The HIFU system also helps the physician determine a course of action to treat and locate the infected areas. The high imaging resolution is just one of the many reasons why many physicians utilize HIFU and the Sonablate 500 in particular. It provides the opportunity to identify all vital structures located around the prostate, including the neurovascular bundles, seminal vesicles, and rectal wall, ensuring only the targets areas are treated, preventing unnecessary damage.


The requirement of the patient before the treatment can begin is to undergo two enemas before the treatment can commence. Patients also undergo light anesthesia to ensure the patient remains still during the procedure as even small movements can cause damage. The rectal probe uses ultrasound waves to also provide-time images to the physician of the complete area, offering immediate and detailed feedback. Once the procedure is complete, patients only need a few hours to recover and in just a few days, patients are able to go back to their life.

 

Benefits of Using the Sonablate 500 for HIFU for Prostate Cancer Treatment

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The Sonablate 500 for HIFU (high intensity focused ultrasound) has been utilized for prostate cancer treatment by Dr. Richard Lotenfoe, who has offices outside of Orlando, Florida. The Sonblate 500 is a minimal invasive treatment technique using a transrectal probe to ensure focus of ultrasound waves on the prostate, to a targeted and precise location. It raises the temperature, causes the tissue to break down, treating the entire prostate. HIFU using the Sonablate 500 takes at most four hours and is considered an out-patient procedure. There are numerous benefits associated with this treatment method, which makes it one of the most utilized HIFU methods currently available.

There is no surgery required with then Sonablate 500 is used. It is currently the only HIFU treatment device that can treat a maximum of 50 CC prostate without the use of an invasive procedure. Because of the design of the Sonablate 500’s probe as well as the transducer’s focal lengths, it offers a therapy zone of 120 degrees. This provides the physician with immediate access to the whole prostate gland with no need to reposition or move the probe. This makes it an out-patient procedure without the need for overnight hospital stay.

Superior imaging is offered by the Sonablate 500. This machine offers reference and real-time images that enable the physician to receive immediate feedback that can be used for maximum precision. The images provided to the physician allow them to plan a custom HIFU treatment. Through the use of three-dimensional imaging, it is possible to accurately plan treatment for the targeted areas.

Possibly one of the biggest worries with any of these types of treatments is the possibility of causing impotency. However, the Sonblate 500’s integrated software and hardware identifies blood flow throughout the neurovascular bundles. Physicians can locate all neurovascular bundles that are associated with potency, avoiding damage to these nerves. Men who have been treated with the Sonblate 500 have fewer problems associated with erectile dysfunction.

Physicians are able to adjust the power throughout the duration of HIFU treatment in areas such as nerve bundles and in close proximity to the rectum. This power adjustment feature provides additional safety and the customization of the HIFU treatment. Other machines do not offer power adjustment capabilities, meaning that all patients are treated with the exact same power level, which is not an ideal situation. Furthermore, the physician has more control over the placement and position of the probe. They are able to adjust it to ensure optimal outcomes as well as comfort. Other probes offer only limited control because they remain fixed to the treatment table. The Sonablate 500 offers a full hands-on approach to the procedure.

Lastly, the Sonablate 500 for HIFU for prostate cancer treatment is quite possibly the most accurate treatment currently available. It can treat the entire prostate area in a number of different overlapping zones. Only small lesions are produced that are very precise. The legions made by the Sonablate 500 are smaller than any other treatment of this variety.
 

 

Advice For Family Members

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When a loved one has Prostate Cancer it can be very stressful on a family.  Families must educate themselves about the healthcare resources and the different kinds of support they have available when someone they love is diagnosed with Prostate Cancer.  Stress can take over our body and minds when we find ourselves in helpless situations and it can be difficult to cope with these emotions over a period of time.  If you look at the “top 10 stressful events of life,” Illness is number 6.  Studies show that spouses/partners suffer just as much-if not more--- stress then their men with prostate cancer.  Communication, support and knowledge of possible procedures that may be performed in the future are things that one’s spouse/partner and family should consider and talk about to help with the stress they may be going through.
Communication between women and men is hard enough.  It is important for couples and families to work together in their communication to reduce the stress levels one may experience while dealing with someone with prostate cancer.  When you add depression and treatment side effects that often follow a diagnosis of prostate cancer, the level of stress can go off the charts for a lot of people.  Talk to your spouse and other family members with an open mind and an understanding of how the other person feels. Whether or not you yourself has prostate cancer or a loved one, talk to each other about the situation with an open mind and understanding and it will greatly reduce the stress level for everyone.
Support groups for wives and partners are available now more than ever for people dealing with prostate cancer.  We encourage you to take advantage of these as much as possible.  Talking with someone who really understands what you’re going through may help to relieve some of your greatest fears and worries.  Online communities for wives and partners are available to you without having to leave the comfort of your own home. Once you become a member, and most are free, you can view, reply and join in conversations with other people that are or already have experienced what you may be going through.
 

 
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